The text is based on the authors' paper at this year's LXXth Symposium on the History of Pharmacy (24/05/2025, Kuks) and summarizes their arguments as to why contemporary Czech pharmaceutical historiography is in an attenuation (decline?) and what are the possible paths to its re-flourishing. The authors see the cause of this situation in an overly narrow conception of the field, focused exclusively on strictly pharmaceutical matters, further in a certain preference for pharmaceutical education as a prerequisite for research into the history of the field and, last but not least, a impression that the picture of the history of pharmacy is already more or less complete with major publications by classics of the field, led by Václav Rusek. The authors see hope for pharmaceutical historiography in its opening primarily towards professional historians, reflection on internationally researched topics related more to the social or cultural history of civilization (and therefore also pharmacy), inter- and over-disciplinary team cooperation, and diversity of perspectives that may not be respected by the currently prevailing view of the linear development of pharmacy as a path of constant progress.
Patient education is increasingly acknowledged as an important aspect of the management of systemic lupus erythematosus (SLE). The aim of the study was to develop the SLE Knowledge Assessment score (SLAKE), a digital multilingual self-assessment tool designed to quantify essential SLE knowledge. International healthcare professionals (HCPs) and patient representatives engaged in a multi-step process to: identify essential SLE knowledge domains, select key domains via rating, and generate an item bank of 394 questions across 11 domains, which was then adapted into 19 languages. For validation, participants completed 44 questions (including 33 randomly selected), with scores calculated for total knowledge and the 11 specific domains. Statistical analyses examined associations between scores and demographic, clinical, and educational variables. SLAKE was used by 1182 SLE participants (1120 [94.8%] women, median age: 45 years [IQR: 35-54 years]), with a median SLE duration of 10 years (IQR: 4-20 years). The median SLAKE score was 37 (IQR: 34-40) of a maximum of 44 points while the median score across the 11 SLAKE domains ranged between 3 and 4 over a maximum of 4 points. There was a significant positive association between SLAKE score and SLE duration (p= 0.006), previous participation to a patient education course or a patient training for lupus (p< 0.0001) and the education level (p< 0.0001) but not with age (p= 0.48) or gender (p= 0.39). SLAKE is a valid, multilingual, digital self-assessment tool that effectively measures essential SLE knowledge. Its randomized question bank and domain-specific scoring enable targeted education, ultimately supporting better disease management.
According to the most recent data published by the World Health Organization (WHO), it is estimated that approximately 332 million persons worldwide suffer from depression. The relationship between depression and alcohol consumption is complex and bidirectional. This study aimed to investigate the effects of cannabidiol (CBD) on behavior and malondialdehyde (MDA) imbalance in female Wistar rats exposed to chronic stress and alcohol. Sixteen intact cycle female 5-month-old Wistar rats were randomly assigned to two groups: the Control group (n = 8), and the CBD group (n = 8), which received CBD at a dose of 10 mg/kg. Following chronic stress induction, during the three-week treatment period, the animals were exposed to alcohol on three separate occasions. CBD-treated females showed increased freezing time in the Open Field test with no clear anxiolytic effect. In the Y maze and Morris Water Maze, they exhibited improved memory-related performance. Brain MDA levels were reduced, while plasma MDA was unchanged. Cortisol tended to be higher in the CBD group. CBD administration showed potential cognitive and central antioxidant effects, but no clear anxiolytic effect.
Nasopharyngeal carcinoma (NPC) is rare in Europe, and emerging data suggest poorer outcomes in Caucasian patients compared with Asian populations, highlighting the need for region-specific prognostic tools. Inflammation-based biomarkers and artificial intelligence show promise for risk stratification and prediction of survival and second primary cancers (SPCs). We conducted a retrospective multicentre study including 405 NPC patients from six European institutions. Demographic, clinicopathological, and haematologic inflammatory markers were collected, and machine learning algorithms were developed to predict 5-year OS and SPC occurrence. Multiple train-test splitting strategies and machine learning (ML) classifiers were evaluated. Models were tested both with and without systemic inflammatory ratios to assess their added prognostic value. The median age was 52 years, 91.6% of patients were classified as White/European ancestry, and 77.3% received chemoradiotherapy. Five-year OS was 66.6%, while 12.8% developed SPC. The Random Forest classifier achieved the best performance for OS prediction (accuracy 0.74; AUC 0.66) using the complete feature set, while SPC prediction reached an accuracy of 0.80 (AUC 0.74). Exclusion of inflammatory markers resulted in a consistent decline in accuracy across all models. Feature-importance analysis highlighted inflammatory ratios among the strongest predictors for both OS and SPC. The present study was reported according to TRIPOD+AI reporting guidelines. This study presents the first machine-learning prognostic models for nasopharyngeal carcinoma derived from a predominantly Caucasian European multicentre cohort. Systemic inflammatory markers modestly improved overall survival prediction and substantially enhanced second primary cancer risk estimation. The resulting models are transparent, cost-effective, and support the potential benefit of prognostic assessment through machine learning in non-endemic settings.
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Obesity and periodontitis are chronic diseases that share inflammatory and metabolic pathways. The RBFOX1 gene was selected as an exploratory candidate gene because it encodes an RNA-binding splicing regulator, has been implicated in obesity-related phenotypes, and has been reported in candidate-gene analyses of periodontitis/metabolic traits. This study investigated the association between obesity, periodontal disease severity, and RBFOX1 rs6500744 polymorphism. This case-control study enrolled 106 adults: 53 with obesity (BMI ≥ 30 kg/m2) and 53 normoweight controls. Clinical and radiographic periodontal assessments determined disease severity, complexity, staging, and grading. Genotyping of the RBFOX1 rs6500744 polymorphism (CC, CT, TT) was performed using the TaqMan® SNP Genotyping Assay and the 7500 Fast Dx Real-Time PCR system. Multivariable models adjusted for age, sex, smoking status, and clinically confirmed type 2 diabetes. Participants with obesity showed higher levels of periodontal disease than normoweight controls, indicated by greater pocket depths, attachment loss, and bone loss. Advanced stage (Stage III/IV; p = 5.35 × 10-6) and Grade C periodontitis (p = 2.08 × 10-7) were significantly more frequent in the obese group. The rs6500744 T allele was more common among individuals with obesity (46.2% vs. 30.2%; OR 1.99, p = 0.023). Periodontal damage appeared to increase progressively from CC to CT to TT genotype, but genotype-stratified estimates, particularly for TT homozygotes, were interpreted cautiously because of the small subgroup size and multiple testing. Both obesity and the number of T alleles were associated with increased periodontal severity in adjusted statistical models. VIFs were low, residual diagnostics did not indicate major assumption violations, smoking-stratified sensitivity analyses were directionally consistent, and the obesity × T-allele interaction was not statistically significant. Obesity is associated with more severe and extensive periodontal disease in this exploratory case-control cohort; however, residual confounding from significant smoking imbalances between groups cannot be excluded. The RBFOX1 rs6500744 T allele may mark increased susceptibility to periodontal tissue destruction, but the findings do not establish causality or clinical prognostic utility and require longitudinal validation in larger, ancestry-controlled populations.
Background: Borderline left ventricle represents a heterogeneous spectrum of congenital heart disease for which accurate prediction of suitability for biventricular versus univentricular circulation is often difficult. Serial fetal echocardiography may provide dynamic information to support postnatal decision-making. Case Presentation: We report the case of a fetus diagnosed at 32 weeks' gestation with a borderline left ventricle, ventricular disproportion, hypoplastic left-sided structures, ductal-dependent systemic circulation, and a non-restrictive ostium secundum atrial septal defect. Serial fetal echocardiographic evaluations demonstrated stable left ventricular dimensions, preserved systolic function, impaired diastolic relaxation, and absence of endomyocardial fibroelastosis. Postnatal echocardiography confirmed hypoplastic aortic arch and coarctation. Following multidisciplinary evaluation, a biventricular repair strategy was selected. At 14 days of life, the patient underwent aortic arch reconstruction and partial atrial septal defect closure with preservation of a small therapeutic interatrial communication. Postoperative evolution was favorable, with progressive left ventricular growth and preserved function. At 2-year follow-up, echocardiography showed normalized mitral and aortic valve z-scores, good left ventricular systolic performance, and no evidence of myocardial fibrosis. Conclusions: This case highlights the value of serial fetal echocardiography in guiding individualized management of borderline left ventricle. Careful assessment of ventricular function and atrial septal physiology may support selection of a biventricular strategy in selected patients and contribute to favorable mid-term outcomes.
Paper presents the principles of modern artificial intelligence (AI), its current capabilities, limitations, and practical applications in pharmacy. The text outlines the development of AI, explains key terms, and introduces the most important models and their capabilities. The objective of the article is to show how AI can support pharmaceutical practice, where its limits lie, and what legislative and safety requirements must be respected when using it. Modern AI models enable text generation, data processing, image analysis, and decision support. In pharmacy, they can speed up data analysis (e.g., LEK-13 reports), facilitate information retrieval, and support the supervision of IPLP preparation. Examples confirm the high efficiency of the models (e.g., GPT-5 in CSV processing), but also reveal the risk of errors and hallucinations. Model performance varies-rankings (e.g., Chatbot Arena) show specific differences between GPT, Gemini, Claude, and open models. Training a computer vision model for capsule counting is feasible on a standard PC and is capable of very high accuracy. AI is an important tool for pharmaceutical practice, but it does not replace the expertise of a pharmacist. It is necessary to understand its principles, limitations, ethical and legislative frameworks (AI Act, NIS2) and always check the outputs. When used correctly, it can significantly increase the efficiency, accuracy, and safety of pharmaceutical processes.
We present the case of a three-year-old child with a history of recurrent wheezy chest and lower respiratory tract infections, who was initially managed as having recurrent viral-induced wheeze. However, persistent symptoms and poor response to standard treatment prompted further investigations, which eventually led to a diagnosis of thoracic neuroblastoma. This case highlights the importance of considering alternative diagnoses in children with recurrent respiratory symptoms, especially when not responding to conventional therapy.
Recent years have seen a notable increase in the number of publications concerning pharmacokinetic drug-drug interactions involving the isoxazolyl penicillins cloxacillin, dicloxacillin, flucloxacillin and oxacillin. Given that the findings predominantly rely on clinical observations, the interaction mechanisms and their clinical relevance remain insufficiently elucidated, thereby posing challenges for clinicians in managing these interactions. The aim of this literature review was to provide an overview of all reported pharmacokinetic drug-drug interactions involving isoxazolyl penicillins and to evaluate the plausible interaction mechanisms. We systematically searched articles reporting potential pharmacokinetic drug-drug interactions involving isoxazolyl penicillins in humans up to November 2025 in Pubmed and Embase. The quality of the articles was assessed using a self-developed risk of bias assessment tool. A modified drug-drug interaction probability assessment tool was used to objectively evaluate the probability of the reported potential interactions. A total of 33 potential victim drugs were identified across 51 articles, comprising 24 case reports or case series, 16 retrospective cohort studies and 11 prospective or crossover studies. Most of the included studies report a decreased exposure and/or efficacy of drugs during concomitant treatment with isoxazolyl penicillins. Although pointing towards induction of cytochrome P450 enzymes, diphosphate-glucuronosyltransferase enzymes and P-glycoprotein as most plausible mechanism for most interactions, the exact interaction mechanisms could not be fully elucidated due to the quality of the study designs and heterogeneity in endpoints. Clinicians should be aware of a potential clinically relevant interaction when combining isoxazolyl penicillins with drugs with a small therapeutic window that undergo extensive metabolism.
Intensive use of glyphosate-based herbicides in genetically modified (GM) and non-GM agriculture has resulted in widespread glyphosate-resistant weeds. In response, the agricultural biotechnology industry has launched GM crops tolerant to glyphosate plus 2,4-D and glyphosate plus dicamba. Consequently, people are increasingly exposed to mixtures of these herbicides, yet no studies have been conducted to assess health risks. Intestinal structure and integrity, as well as gut microbiome composition and function, are recognised contributors to disease. Therefore, we investigated the effects of glyphosate alone and in combination with 2,4-D and dicamba on gut structure and function. Pregnant Wistar rats were administered via drinking water from gestation day 6 with glyphosate at the European Union (EU) no observed adverse effect level (NOAEL: 50 mg/kg bw/day) and acceptable daily intake (ADI: 0.5 mg/kg bw/day), and with an ADI mixture of glyphosate (0.5 mg/kg bw/day), 2,4-D (0.02 mg/kg bw/day) and dicamba (0.3 mg/kg bw/day). Offspring continued this regimen for 13 weeks post-weaning. Large and small intestinal tissues and gut content were isolated and analysed for inflammation, gut epithelial integrity, oxidative stress, microbiota composition and histopathology. The glyphosate NOAEL and, to a greater degree, the glyphosate, dicamba, 2,4-D mixture resulted in increased gut inflammation and permeability, associated with oxidative stress and altered microbial composition. Histological analysis confirmed structural alterations and inflammation in large and small intestine. Effects were more pronounced in large intestine and females. Our results identify exposure to glyphosate alone and a mixture of glyphosate, 2,4-D and dicamba as risk factors for gut structure and function dysbiosis. The online version contains supplementary material available at 10.1007/s00204-026-04409-9.
Identifying predictors of unfavorable disease course in pediatric ulcerative colitis (UC) will impact therapeutic strategy. We aimed to define predictors of nonremission 2 years after diagnosis in pediatric patients with UC. This retrospective analysis of prospectively collected data from ImproveCareNow included pediatric UC patients (<18 years) diagnosed between 2007 and 2023 with at least a 2-year follow-up. Remission was defined as a pediatric UC activity index (PUCAI) < 10 points. Statistical analysis was performed using the International Business Machines Corporation Statistical Package for the Social Sciences (SPSS) version 29. Demographic information at diagnosis/enrollment (T0), first visit (T1) and follow-up (T2, closest to 24 months) were calculated between relevant groups. Binary logistic regression was used to identify outcome predictors. Multiple imputation was used for missing data. This study was approved by the Ethics Committee (Protocol 23135-ICN_UC). We included 1290 pediatric UC patients. Two years after diagnosis, 390 patients (30%) were not in remission at T2. Differences in disease severity and treatment were observed at T1 and T2. PUCAI (mild odds ratio [OR] = 1.946, moderate OR = 1.735, or severe disease OR = 3.183, p < 0.01), the use of immunomodulators (IM) (OR = 0.631, p = 0.053) and body mass Index (BMI) z-score (OR = 1.149, p = 0.022) at T1 (mean 30 days) predicted non-remission at T2 with poor discriminating ability (area under the curve 0.599-0.621). Predictors for unfavorable disease course were increasing disease severity according to PUCAI (vs. inactive disease), increasing BMI z-score (per z-score increase) and nonuse of IM at T1. These predictors may impact therapeutic strategy shortly after diagnosis.
Carpal tunnel syndrome (CTS) is the most common compressive mononeuropathy. In patients with type 2 diabetes mellitus (T2DM), chronic hyperglycemia, microangiopathy, and systemic inflammation increase the vulnerability of peripheral nerves to compression. This study aimed to assess the relationship between CTS severity and clinical, metabolic, inflammatory, and electrophysiological parameters in patients with T2DM. A cross-sectional study was conducted from June 2023 to June 2024, involving patients diagnosed with T2DM. Electrophysiological assessment of the upper and lower limbs was performed using a four-channel electromyography apparatus. Clinical and anthropometric data and laboratory parameters were obtained, as well as the results of nerve conduction studies (NCS). One hundred and twenty-three patients with T2DM were included in the study. The prevalence of moderate-to-severe forms of CTS was 43.9%, and bilateral involvement was present in 21.95% of patients. Patients with moderate-to-severe CTS had significantly higher hemoglobin A1c (HbA1c) (p = 0.004), glycemia (p < 0.001), and Triglyceride-Glucose Index (p = 0.018) compared with those without CTS/with mild forms. The number of monocytes was significantly higher in the group with moderate-to-severe forms (p = 0.012), suggesting a chronic inflammatory state. In the logistic regression analysis, hemoglobin HbA1c emerged as an independent predictor of CTS severity, with each 1% increase associated with approximately a 60% higher risk of moderate/severe CTS. NCS analysis showed significant correlations between median nerve parameters and those of the lower-limb peripheral nerves, particularly the tibial and sural nerves, suggesting an association with generalized diabetic peripheral neuropathy. Professional activity was significantly associated with moderate-to-severe CTS (OR = 3.5). CTS is a common complication in patients with T2DM and is associated with worse glycemic control, insulin resistance, systemic inflammation, and peripheral neuropathic damage.
This pilot study examines disability knowledge, everyday interactions with people with disabilities (PWD), emotional responses to disability, familiarity with assistive technologies, and transhumanist orientation among 863 Romanian adults aged 19 to 45. Results suggested that participants generally reported limited knowledge about disability and assistive technologies, with sadness emerging as the dominant emotional response to disability. Greater disability knowledge was associated with higher knowledge of assistive technologies, which in turn predicted a stronger transhumanist orientation. Assistive technology knowledge mediated the relationship between disability knowledge and transhumanist orientation. Positive interactions with people with disabilities were linked to stronger endorsement of transhumanist orientations. These exploratory findings suggest that assistive technologies may function as a conceptual bridge between social understandings of disability and broader orientations about human enhancement, highlighting the importance of knowledge of assistive technologies in shaping contemporary disability attitudes.
As the global population ages, an increasing number of older adults progress to end-stage kidney disease (ESKD). In this population, frailty, multimorbidity, and functional decline often limit the survival benefit of dialysis, challenging the conventional approach to renal replacement therapy. To summarize current evidence comparing dialysis with conservative kidney management (CKM) in older adults with advanced chronic kidney disease (CKD), focusing on survival, quality of life, hospitalization, and prognostic tools. A narrative synthesis was conducted based on observational, cohort, and systematic review studies including adults aged ≥ 70 years with stage 4-5 CKD. The literature search was performed exclusively in the PubMed database, which represents a methodological limitation of this review. Search terms included: end-stage renal disease, chronic kidney disease, kidney failure, dialysis, conservative management, frailty, geriatric patients, and elderly patients. Outcomes were grouped into four domains: survival, quality of life, healthcare utilization, and prognostic models. Across studies, dialysis prolonged survival mainly in younger and less comorbid patients, but this advantage diminished with increasing frailty and multimorbidity. CKM provided comparable or superior health-related quality of life (HRQoL) and was associated with fewer hospitalizations. Patients managed conservatively were more likely to die at home, reflecting closer alignment with end-of-life preferences. Prognosis was primarily determined by patient-level factors-age, frailty, and eGFR decline-rather than by treatment modality. CKM-specific prognostic models remain limited. In older adults with advanced CKD, survival gains from dialysis are modest and frequently offset by higher treatment burden. CKM offers a patient-centered alternative focused on quality of life, comfort, and goal-concordant care. The development of validated CKM-specific prognostic tools is essential to support individualized, evidence-informed decision-making.
Identifying predictors of poor outcomes (POPO) in paediatric Crohn's disease (CD) may guide therapy. We assessed predictors of 2-year non-remission (primary outcome) and time to first remission (TFR), corticosteroid-free remission (TCSFR, ≥3 months corticosteroid (CS) withdrawal and sustained remission (TSR, ≥6 months) (secondary outcomes) in paediatric CD. We retrospectively analysed prospectively collected data from 6959 paediatric CD patients (<18 years; 2007-2023) in the ImproveCareNow Registry. Remission was defined as a short Paediatric CD Activity Index <10. Logistic and Cox regression (α = 0.05), using R 4.5.0 with multiple imputation, identified predictors for both outcomes (at 0, 1, 5, 6, 12, and 24 months). For the primary outcome, 53/794 patients (6.7%) failed to achieve remission during 2-year follow-up. Female sex (odds ratio [OR] = 3.12, 95% confidence interval [CI] 1.48-6.55) and need for ustekinumab after 1 year (OR = 14.70, 95% CI 4.37-49.46) predicted non-remission. For the secondary outcomes (n = 3290), mean TFR, TCSFR and TSR were 4.5, 16.4, and 8.2 months, respectively. Longer TFR was predicted by female sex (hazard ratio [HR] = 0.81, 95% CI 0.71-0.92) and the need for infliximab (IFX, HR = 1.15, 95% CI 1.00-1.32) at first visit. Longer TCSFR was associated with female sex (HR = 0.85, 95% CI 0.78-0.93), race (white HR = 0.83, 95% CI 0.74-0.93 and Asian HR = 1.42, 95% CI 1.05-1.92) and type of treatment at first visit (faster if IFX, slower if CS or immunomodulators). For TSR, predictors included age at diagnosis (HR = 1.06, 95% CI 1.02-1.11) and body mass index (BMI) (HR = 0.97, 95% CI 0.94-1.00). Clinical parameters (female sex, younger age, and higher BMI) and therapeutic strategy (early/late use of biologicals) are POPO and associated with longer time to remission in paediatric CD.
Given the decline in performance in German fencing since 2012, systematic athletic training has become increasingly important in youth development. This study is the first to investigate the effects of structured athletic training on physical performance parameters in German youth fencing. In a twelve-month interventional cohort study, 22 youth fencers (aged 13-17 years) from a performance centre were examined. The intervention group (n=12) completed 60 minutes of structured athletic training per week in addition to regular fencing training, while the control group (n=10) performed an exclusively fencing-specific training. Pre- and post-tests included standing long jump, 10 m sprint, T-test, rotational throw, Bourban test, and beep test. The intervention group also underwent Functional Movement Screen (FMS), Y-Balance test, and Skillcourt assessments. Statistical analysis was performed using t-tests and Mann-Whitney U tests, supplemented by effect sizes (Cohen's d). Compared with the control group, the intervention group showed significant improvements in explosive strength (sprint: p=0.023, d=1.31; T-test: p=0.043, d=1.00; rotational throw right: p=0.023, d=1.05; left: p=0.003, d=1.44) and endurance (beep test: p=0.002, d=1.54). Core stability showed a trend towards significance (p=0.065, d=0.84). Within the intervention group, flexibility improved significantly (FMS: p=0.002, d=1.14; Y-Balance lower extremity right: p=0.012; left: p=0.019). Structured athletic training produces large to very large training effects in fencing-relevant physical performance parameters. The results provide evidence-based support for the integration of systematic athletic training into youth development programmes in German fencing. Angesichts des Leistungsrückgangs im deutschen Fechtsport seit 2012 gewinnt systematisches Athletiktraining im Nachwuchsbereich an Bedeutung. Diese Studie untersucht erstmals die Effekte eines strukturierten Athletiktrainings auf die konditionellen Leistungsparameter im deutschen Jugendfechten.In einer 12-monatigen interventionellen Kohortenstudie wurden 22 Jugendfechter (13–17 Jahre) eines Leistungsstützpunkts untersucht. Die Interventionsgruppe (n=12) absolvierte zusätzlich zum regulären Fechttraining wöchentlich 60 Minuten strukturiertes Athletiktraining, die Kontrollgruppe (n=10) trainierte ausschließlich fechtspezifisch. Prä- und Post-Tests umfassten Standweitsprung, 10m-Sprint, T-Test, Rotationswurf, Bourban-Test und Beep-Test.Zusätzlich wurden in der INTERVENTIONSGRUPPE: Functional Movement Screen (FMS), Y-Balance-Test und Skillcourt erfasst. Die statistische Auswertung erfolgte mittels t-Tests und Mann-Whitney-U-Tests, ergänzt um Effektstärken (Cohenʼs d).Die Interventionsgruppe zeigte signifikante Verbesserungen gegenüber der Kontrollgruppe in der Explosivkraft (Sprint: p=0,023, d=1,31; T-Test: p=0,043, d=1,00; Rotationswurf rechts: p=0,023, d=1,05; links: p=0,003, d=1,44) und Ausdauer (Beep-Test: p=0,002, d=1,54). Die Rumpfstabilität zeigte einen Trend zur Signifikanz (p=0,065, d=0,84). Innerhalb der Interventionsgruppe verbesserte sich die Beweglichkeit signifikant (FMS: p=0,002, d=1,14; Y-Balance untere Extremität rechts: p=0,012, links: p=0,019).Strukturiertes Athletiktraining führt zu großen bis sehr großen Trainingseffekten bei fechtsportrelevanten konditionellen Parametern. Die Ergebnisse liefern evidenzbasierte Grundlagen für die Integration systematischen Athletiktrainings in die deutsche Nachwuchsförderung im Fechten.
The microbiological diagnosis of severe pneumonia in intensive care unit (ICU) patients remains challenging. We investigated whether amplicon-based sequencing (ABS) could provide additional value in this setting. Bacterial 16S rRNA coupled with fungal internal transcribed spacer (ITS) ABS was compared with standard of care (SOC) comprising cultures, PCR and galactomannan on bronchoalveolar lavages of immunosuppressed and immunocompetent ICU patients presenting severe pneumonia (n = 24) and noninfected lung-transplanted patients (n = 12). The ABS-matched SOC results were complete for 20/36 (55.5%) samples. Regarding 16S rRNA, ten samples showed partial agreement, whereas five others were fully discordant. Discordances were observed mainly for gram-negative organisms, either for quantification (Enterobacteria) or identification (Enterobacter sp., Haemophilus sp.). Only 1 of the 36 ITS results were discordant with the SOC results. The ABS has proven to be more valuable in immunosuppressed patients. Despite limitations in bacterial identification, pathogens not reported by SOC were detected in 8 samples (coinfections, bacterial superinfections from viral pneumonia). ITS identification was reliable, and semiquantification helped distinguish P. jirovecii infection and colonization. The correlation between galactomannan and ITS was good. While 16S rRNA sequencing is interesting for severe pneumonia of undefined aetiology in IS patients, ITS could provide additional diagnostic value for severe fungal pneumonia.
Dilated cardiomyopathy (DCM) in children is rare, but carries a high risk of progression to advanced heart failure (HF) and heart transplant (HTx). Improved short-term risk stratification is essential; however, robust pediatric prognostic tools remain limited. We aimed to evaluate the 1-year prognostic value of multichamber speckle-tracking echocardiography (STE) and biomarkers, including age-adjusted N-terminal pro-B-type natriuretic peptide (NT-proBNP) and vitamin D, in children with DCM. In this single-centre prospective cohort study, 29 children with idiopathic DCM and 27 age- and sex-matched healthy controls underwent standardised clinical, laboratory, and echocardiographic assessment. The primary endpoint was a 12-month composite of implantation of an implantable cardioverter-defibrillator (ICD), left-ventricular assist device (LVAD), HTx, or all-cause mortality. During a 1-year follow-up, 9/29 (31%) DCM patients experienced major events. Compared with event-free patients and controls, children with events had more impaired LVGLS (-5.99 ± 2.45% vs. -13.44 ± 6.88% and -19.98 ± 3.25%), lower LASr (10.97 ± 7.67% vs. 25.36 ± 10.28% and 44.0 ± 11.43%), and reduced RVFWSL (-15.32 ± 5.24% vs. -23.13 ± 8.55% and -24.78 ± 4.45%; all p < 0.01). Zlog NT-proBNP was markedly higher in the event group (5.37 [5.00-6.08] vs. 2.28 [0.71-3.68] and 0.14 [-0.02-0.88]). LVGLS, Zlog NT-proBNP, and LASr showed excellent discrimination for 1-year events (AUC 0.91, 0.91, and 0.87, respectively), with clinically applicable cut-offs (LVGLS ≥ -8%, Zlog NT-proBNP ≥ 4.6, LASr ≤ 21%). In conclusion, multichamber strain imaging combined with age-adjusted NT-proBNP provides clinically relevant, exploratory markers for short-term risk stratification in pediatric DCM, supporting earlier intensification of follow-up and timely referral for advanced heart failure therapies. These findings warrant validation in larger multicenter cohorts.
Testicular cancer represents the most common solid tumor in young adult males and is associated with excellent long-term survival outcomes. The aim of this study is to evaluate clinical and pathological characteristics, treatment strategies, and survival outcomes of a large Romanian institutional cohort. We conducted a retrospective study including 246 patients with testicular cancer treated at a tertiary oncology center between January 2005 and December 2015. Clinical, pathological, and treatment data were extracted from institutional medical records, and survival outcomes were obtained from administrative registries. Overall survival was estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Cox proportional hazards regression was used to estimate adjusted hazard ratios with 95% confidence intervals. The study included 246 patients, with a mean age at diagnosis of 32.3 years. Non-seminomatous mixed germ cell tumors were the most frequent histological subtype, followed by seminoma. Stage I disease was the most common presentation, while approximately one-third of patients had advanced disease. At last follow-up, 210 patients (85.4%) were alive. Survival was significantly better in early-stage disease and worse among patients with advanced stage and poor IGCCCG risk. In this Romanian cohort, nearly one-third of patients with testicular cancer presented with advanced-stage disease, and non-seminomatous tumors were the most frequent histological type. Long-term outcomes were excellent for stage I-II disease, while advanced stage and poor IGCCCG risk were associated with worse survival.